Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus

Michael Phan,Melissa Erwin,Emily Sou,Ghadah Al Sannaa,Ramon Sanchez

doi:10.7759/cureus.9343

Michael Phan, Melissa Erwin + Show 3 more

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https://doi.org/10.7759/cureus.9343

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Journal: Cureus	Publication Date: Jul 22, 2020
Citations: 2	License type: cc-by

Affiliation: The University of Texas Medical Branch at Galveston

Abstract

Lichen sclerosus et atrophicus (LSA) may present in a rare bullous and hemorrhagic form that is often difficult to recognize both clinically and histopathologically. Clinically, the lesions may be characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions. Histologically, fully developed lesions of LSA are characterized by a thinned, effaced epidermis with interface change, a wide band of hyalinization in the upper dermis, and a lymphohistiocytic infiltrate below the hyalinized area. Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation. With increased fragility of dermal capillaries, hemorrhage can accumulate within the bullae. Recognizing prominent upper dermal hemorrhage as a secondary change may lead to a prompt diagnosis of LSA. We present a case of extragenital LSA that mimics a dermal hemorrhage clinically and histologically in a 71-year-old Caucasian woman.

Highlights

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory condition often characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions
Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation
Recognizing prominent upper dermal hemorrhage as a secondary change may lead to a prompt diagnosis of LSA

Summary

Introduction

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory condition often characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions. Rare variants, such as bullous and hemorrhagic forms of LSA, are often more difficult to recognize both clinically and histopathologically. A 71-year-old Caucasian female patient with no prior history of skin cancer presented with a red, painful, and enlarging plaque on her right breast for several weeks. This lesion has not been treated in the past and she denies genital lesions.

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Vukicevic J